Care Home: Ladymead Nursing Home

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What the care home does well The service provides a good standard of nursing care to older people in a homely environment. All residents spoken with said that the food was good and there was evidence of a choice of menu providing home cooked food. The cook said that pre prepared food is rarely used. Care plans were comprehensive and gave instructions to staff on how to meet the care needs of the residents and those being nursed in bed appeared comfortable. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.2 Staff said they are well supported by management through regular supervision and that their training provides a good knowledge base to meet residents needs appropriately. What has improved since the last inspection? Since the last inspection an activities plan has been put in place. Residents now have the opportunity to participate in regular activities in the home (although not all of these were in line with residents preferences) In respect of the environment, the bathrooms have been upgraded, a new hoist has been purchased, an eight person lift installed, one en-suite has been added to a bedroom (there are plans to duplicate this in all bedrooms), all radiators have been covered and water coolers have been positioned throughout the home. The Registered Provider has undertaken monthly inspections and from his findings he has devised a detailed improvement/action plan for areas that will be improved upon in the coming year. Health and safety checks and environmental risk assessments are in place. A full time administrator has been recruited to assist the manager with record keeping and administrative systems. Three vacant posts (RGN, Care worker and kitchen assistant) have been filled and the new staff are due to commence employment in Nov/Dec 2009. What the care home could do better: The home has identified improvements to the home and these were outlined in their AQAA prior to the visit. The home has also devised an improvement/action plan for on going developments. Some of these improvements are already underway; others were identified during the visit and contained in the body of the report. Some areas for improvement include; Specialist staff training (mental capacity, deprivation of liberty and end of life care) to improve staff knowledge in these areas. Care plans need to be in better order/electronic to access information more easily. Residents social care plans need to be more detailed and matched with activities relevant to residents assessed social care needs and preferences. Refurbishment plans to improve the internal/external areas of the home. Implementation of regular staff and residents/relatives meetings Induction and recruitment of staff to ensure residents needs are fully met.Ladymead Nursing HomeDS0000024169.V378432.R01.S.doc Version 5.2 The Commission has requested that, as each aspect of the improvement plan is implemented, the home notifies the Commission in writing. This will enable us to keep our own records up to date and record on going improvements made to the service. Key inspection report CARE HOMES FOR OLDER PEOPLE Ladymead Nursing Home Albourne Road Hurstpierpoint Haywards Heath West Sussex BN6 9ES Lead Inspector Beth Tye Key Unannounced Inspection 24th November 2009 10:00 DS0000024169.V378432.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladymead Nursing Home Address Albourne Road Hurstpierpoint Haywards Heath West Sussex BN6 9ES 01273 834873 01273 834745 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Warren Ball Mr Philip Hale Mr Motilall Jagannath Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 27. Date of last inspection 13th November 2007 Brief Description of the Service: Ladymead is a care home registered to provide nursing care for 27 older people. The home is situated in the village of Hurstpierpoint close to village amenities. Mr W Ball and Mr P Hale own the service. Ladymead is a three storey large detached house, a conservatory has been added which has provided additional communal space. 17 single and 5-shared bedrooms are available for residents on the ground and first floor. A passenger lift is available to access those rooms on the first floor. Large gardens, which overlook the South Downs, are to the rear and side of the home. There are plans to extend the premises in the near future. Fees charged as of November 2009 are from £575-£825 per week. Extra services provided such as Chiropody and Hairdressing are charged separately and this information can be provided by the home. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has been rated as two stars, which is a Good quality rating. The site visit was undertaken by Ms Beth Tye, as part of the inspection process. It took place on 24th November 2009 between 10.30 and 3pm. The registered manager facilitated the inspection and was present during the visit. An Annual Audit Questionnaire Assessment had been completed by the manager and forwarded to the Commission prior to the visit. All documents required on the day were made available. Ten comment cards were received from residents, all filled out with the aid of relatives who added their own comments, three were received from professionals and three by staff working at the home. These comments were all positive. Comments from residents, families and professionals elicited by the homes own quality assurance systems were seen in the home and these were also very positive. We looked at four residents care plans, daily recording, health charts and medicine administration charts. We spoke with three relatives and six residents, all spoke well of the home and the care offered, which they said was delivered in a respectful manner. The atmosphere in the home was very relaxed and sociable. Some of the residents were sitting in the lounge socialising. Others were seen in their rooms listening to music, reading, watching television or with visitors. This report is compiled using information as described above and also information held on file at the Commission. What the service does well: The service provides a good standard of nursing care to older people in a homely environment. All residents spoken with said that the food was good and there was evidence of a choice of menu providing home cooked food. The cook said that pre prepared food is rarely used. Care plans were comprehensive and gave instructions to staff on how to meet the care needs of the residents and those being nursed in bed appeared comfortable. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.2 Page 6 Staff said they are well supported by management through regular supervision and that their training provides a good knowledge base to meet residents needs appropriately. What has improved since the last inspection? What they could do better: The home has identified improvements to the home and these were outlined in their AQAA prior to the visit. The home has also devised an improvement/action plan for on going developments. Some of these improvements are already underway; others were identified during the visit and contained in the body of the report. Some areas for improvement include; Specialist staff training (mental capacity, deprivation of liberty and end of life care) to improve staff knowledge in these areas. Care plans need to be in better order/electronic to access information more easily. Residents social care plans need to be more detailed and matched with activities relevant to residents assessed social care needs and preferences. Refurbishment plans to improve the internal/external areas of the home. Implementation of regular staff and residents/relatives meetings Induction and recruitment of staff to ensure residents needs are fully met. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.2 Page 7 The Commission has requested that, as each aspect of the improvement plan is implemented, the home notifies the Commission in writing. This will enable us to keep our own records up to date and record on going improvements made to the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. All residents have a personalised needs assessment to ensure their needs can be identified and met. Contracts are provided and prospective residents and their relatives can visit the home prior to admission. Intermediate care is not offered at Ladymead. EVIDENCE: Pre-admission documents seen during the visit confirmed that the manager assesses individuals prior to admission. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 10 Pre-admission assessments were examined for four residents. These identified relevant areas of need including, nursing, mobility, communication, health and social needs. Files seen contained correspondence from external health professionals such as social services and health. Records demonstrated the information collated prior to admission is then translated into care plans and reviewed on a regular basis by the manager. All records are kept in a locked office only accessible by care staff to ensure confidentiality. Residents and three relatives spoken with on the day confirmed they were given up to date information about the home prior to admission, including a Service Users guide and complaints procedure. Pre admission visits and printed literature helps residents (and their families) to make an informed decision about moving to the home and what to expect. The home does not have a web-site at present but the improvement plan for the coming year noted this will be underway by December 2009. All residents have received a copy of their Terms and Conditions for the home, which they or their families had signed following admission. This informs residents of their rights and what to expect of the home. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have appropriate training and information to ensure they are able to meet residents health needs. Risk assessments and daily recording specific to individual need promote the welfare and well being of residents. Medication is dispensed in line with the homes policies and procedures. Current care practices ensure residents feel they are treated with respect and their right to privacy has been upheld. EVIDENCE: During the visit we looked at four care plans. Each care plan contains relevant details relating to the residents health needs and social well-being, they also detailed aspects of health, personal and basic social care needs. They also contained the actions staff needed to take to meet these needs. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 12 Information seen on care files was up to date although were not easily accessible as all the records were hand written and some were difficult to read. The manager confirmed that in order to combat this, the management intended to computerise all care plans next year. This was supported by requirements made on the homes improvement plan. There was evidence to demonstrate that the manager undertakes regular care reviews for residents, and up date the care plans as changes occur. At present there is not a section for capacity or deprivation of liberty issues on the care plans. Nor is there a section to include input from residents (where possible) and/or family members. Despite this, relatives spoken to on the day confirmed that the manager and staff are very good at communicating any issues with them in person about their relatives. A written record of this would demonstrate the home has consulted with involved parties as appropriate. Health and social care records seen showed that the care provided was relevant to individuals assessed needs and links are established with community health professionals to provide this. These include a weekly visit to the home by a GP, regular visits by the chiropodist (six weekly) dentist (six monthly) and optician (annually). The home has good links with community agencies. Records of visits and correspondence relating to this were seen on resident’s files. Daily records, risk assessments and a monthly observation sheets are kept for each resident. Records seen were up to date and relevant to individuals care. Records demonstrated that staff complete a full induction which covers all aspects of the mandatory training programme. Some staff have undertaken the National Vocational Qualification Level 1, 2 and/or 3 in Care Skills. This provides them with the skills and knowledge base to respond appropriately to resident’s health care needs. Feedback and discussion with the residents and their relatives confirmed good practice is maintained in the home and residents are treated with dignity and respect. We observed staff directly and indirectly and noted that they were friendly, caring and professional with the residents, and the residents were at ease with the staff. One residents whose daughter was visiting said ‘the home is very good I don’t have to worry about mum anymore as I know she is being really looked after’ Other comments on feedback forms included ‘The home does really well looking after its residents’ and ‘the staff are always kind and friendly. They treat X with great respect.’ Staff were observed communicating with residents in a caring and respectful manner. All residents spoken to said they were very well looked after and staff attention was prompt.’ Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 13 The medication administration procedures were discussed and policies and procedures are in place to ensure safe medication administration. A random selection of medication (including controlled drugs) was checked and found to be in order. Medication administration charts are completed correctly, which indicated that residents are receiving their medication as prescribed. Photographs of residents are displayed on records as an extra safeguard towards safe administration. The staff in the home have completed a training course in respect of Death and Bereavement. Although at present the care plans in the home do not include detailed plans for resident’s final wishes in respect of palliative and end of life care. The manager stated he is planning to undertake the Gold Standards Framework training by September 2010. This is identified on the homes improvement plan. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make decisions and choices in their lives. Some activities are offered to residents on a regular basis. However, this needs to be more relevant to individual preferences and choice. Residents are encouraged to maintain contact with family and friends and links with the local community are maintained. Residents are offered a varied diet of good home cooked food. EVIDENCE: On the whole, routines are flexible to meet resident’s needs. Residents confirmed that they can choose whether they want to join in with social events, establish their own routines and also what times they go to bed and get up in the morning. Flexibility enables individuals to have choice and express a preference in their daily lives. An activities plan is on display in the home which included arts, craft, board games, singing and flower arranging. This is an improvement from the last inspection and residents spoken to state they enjoyed most activities on offer. However, life histories and social care plans seen on care files were basic and could not be tracked to the individual social care provided. The homes Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 15 improvement plan for 2009/10 identified that ‘there was not enough choice in activities’ and ‘activities need to be varied and popular’. There is a plan to implement ‘an outcome based rating system’ to measure the resident’s responses to activities held in the home. This would be useful to ensure that residents are being offered activities that are relevant and they have a specific interest in. Residents would also benefit from regular one to one social time with staff. Residents and relatives confirmed that the visiting arrangements for the home are open and visitors can come and go as they please and are made welcome by the staff. Feedback forms confirmed relatives felt ‘welcomed’ and ‘involved’ by the home. The manager holds residents meetings on ‘an irregular basis’. There are plans to ensure meetings occur six monthly and also to implement a newsletter for residents and relatives. This would demonstrate that residents and their families are informed and encouraged to participate in decision-making about the care the home provides. During the visit staff were observed interacting with the residents. Staff were seen throughout the day being respectful, kind and sensitive to residents needs. The majority of feedback from relatives and residents in surveys and during the visit was very complimentary about the staff and confirmed they provided a good standard of care. The menu offered at the home takes in to account the preferences of residents and specialist dietary needs, which are recorded on care plans. This promotes choice for the residents and provides an opportunity for them to eat what they prefer. An alternative meal is on offer at lunchtime and teatimes. Residents spoken with said they ‘really enjoyed the food’ and it was ‘always very good’ and ‘there is always plenty to eat.’ Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users feel safe and listened to, their legal rights are protected and staff are trained to protect vulnerable adults. EVIDENCE: The home has a complaint procedure, which is outlined in the statement of purpose and displayed in the home and is available to all residents, staff and visitors. Residents said they felt safe and listened to and are able to speak to staff and the manager if they were not happy. Complaints are recorded and investigated with feedback to complainant within 28 days with the actions taken. All residents and visitors spoken with said they knew who to complain to and that they would do so if they thought it appropriate. Staff induction and training records indicated that all staff receive training in safeguarding vulnerable adults. Staff spoken to, did know what to do if they suspected abuse. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 17 Staff personnel files seen during the visit, were in very good order and held all appropriate checks and references. This ensures residents are safeguarded from risk of harm. Regular staff meetings within the home encourage feedback about how the home is run and could be improved upon. At present these meetings are sporadic and staff reported they occur ‘very occasionally’. Information on advocacy services is available if needed. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely environment to the people who live there. The bathing facilities are able to meet the needs of all residents. Resident’s bedrooms are personalised. Equipment and safety checks necessary to ensure the welfare of the residents are in place. There are some areas of the garden patio that still need attention to ensure the residents can use the space safely. EVIDENCE: The home was clean and had a warm and welcoming atmosphere. Lots of flowering pots of plants were around the entrance which made the home look inviting and the entrance hall clean and bright. The patio area in front of the home has been renovated although there were still some areas that could be a risk to residents and there are some areas in Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 19 the garden which people with limited mobility would find difficult if not dangerous. The majority of rooms were visited and all were clean, well furnished and have been personalised by residents with small items of furniture, ornaments and photographs. Some areas of the home would benefit from re-decoration and refurbishment. Although, communal areas were clean and homely and the dining room was much improved since the last inspection, with use of white linen table cloths, and a brighter decor. The rooms of those residents spoken with showed individuals had been able to personalise their rooms and they were clean and well presented and had the equipment indicated from their risk assessments. Residents generally said they liked their rooms and thought they were comfortable. Since the last inspection the bathrooms have been upgraded, a new hoist has been purchased, an eight person lift installed, one en-suite has been added to a bedroom (there are plans to duplicate this in all bedrooms), and water coolers have been positioned throughout the home. There are hoists, bath aids and specialist equipment to promote the independence of those who require assistance with personal care and nursing needs. Laundry and sluice facilities are provided. Policies and procedures are in place for infection control, and all of the staff have attended relevant training for infection control and health and safety procedures. This promotes good practice in the area of safety and welfare for the residents and reduces the risk of infection spreading within the home. There is a large passenger lift for residents with limited mobility to access all floors of the house. Radiators throughout the home have been covered except for one which has been risk assessed and shown not to pose any risk to residents due to its position. In accordance with a requirement made at the last inspection, records showed that the water temperatures are taken before bathing residents to prevent risks of injury. In addition water temperature checks are taken monthly through out the home, to ensure water systems meet with health and safety standards. This requirement has now been met. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 20 A call bell system is provided in every room so staff can attend an emergency situation swiftly, should it arise. A part time maintenance man employed to maintain the home and gardens. Records seen demonstrated that the home has all relevant health and safety checks in place, which are up to date and in good order. This means the resident’s home is kept safe and well maintained. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, staff are employed in sufficient numbers and receive suitable training to meet the needs of the residents in the home. Robust recruitment procedures safeguard the residents. EVIDENCE: Discussions with staff, and residents, and an examination of the duty rotas showed that there are generally sufficient staff on duty over a twenty-four hour period to meet the needs and expectations of the residents in the home. Staff reported there have been occasions when there are limited staff on the morning shift and this meant, at times, not all residents’ needs were fully met. In response, the manager stated he has recently recruited a new RGN, a care worker and kitchen assistant. They are due to start work in December 2009. This will improve the staffing levels and provide additional management support to care workers. Catering and domestic staff support care staff. Following examination of staff records it was concluded that, recruitment procedures in the home are good and in line with the homes recruitment Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 22 policies. All staff files seen were found to contain the necessary documentation required by Schedule 2 of the Care Regulations. Training records of four staff files were looked at during the visit. They showed that staff receive induction training which includes all aspects of care in the home, health and safety and best practice guidance. The staff induction sheet includes reference to appropriate policies and procedures and a checklist covering all aspects of the home which is overseen by the manager. The mandatory training for staff covers fire safety, manual handling, health and safety, adult protection and infection control. In addition the home has provided some specialist training to meet assessed needs of the residents. This includes; Dementia, Death and Bereavement, Nutrition and Diabetes. The manager has a training programme in place which identifies training needs and timetables refresher updates. There are plans for the home to provide more specialist training to staff such as the Deprivation of Liberty and Mental Capacity Act. The majority of the staff employed by the home have completed the National Vocational Qualification in Level 1, 2 and/or 3. Examination of training records, observation and feedback from surveys and during the visit highlighted that staff are skilled and competent in their roles. Staff spoke with during the visit were clear about their roles and responsibilities and how to respond appropriately to residents needs. Comments made about the staff by the residents and their families included ‘staff treat the residents as individuals’, ‘compassionate’, ‘pleasant and cooperative’ and ‘the staff are very good’. This was supported by observation of care practice and examination of care records during the visit. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a well-qualified and competent manager and is run in the best interests of residents. Resident’s financial interests are safeguarded and overall the health and safety of residents is promoted and protected. EVIDENCE: The manager has been in post for a number of years and has suitable experience and qualifications to ensure that the services offered by the home meet the needs of the residents who live there. Residents, their Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 24 representatives and staff, said that the home was run in a professional and caring manner. A quality monitoring process, which consists of annual questionnaires to residents and their representatives, is in place. More regular residents/relatives meetings and records of their contribution to care planning and decision making, would improve upon this. The provider makes monthly visits as required by Regulation 26 and the action points form the basis of the homes improvement plan for the coming year. The improvement plan stated that previously administration and record keeping was a low priority. More recently the home has recruited an administrator who assists the manager to ensure more efficient systems are in place and completed on a regular basis. The records seen during the visit were up to date and generally in good order, although management recognise the need to continue to further improve in this area. Staff feedback reflected that the management provides good leadership and direction. Staff spoken to stated ‘the manager is fair’ and ‘supportive’. This enables staff to seek guidance when needed. The home has policies and is improving up to date administrative procedures to support care practice within the home. All care records and documentation seen was in good order although not all information was easily accessible. Staff confirmed they receive regular supervision with the manager. Notes seen on their files supported this. They also undertake an induction and training relevant to their role. This promotes good practice in the home and helps identify learning needs. More regular staff meetings would provide them the opportunity to contribute to the way the home is run. This has been identified in the improvement plan. Residents are encouraged to manage their own finances or if this is not viable and a representative of the resident take on the responsibilities for this. No resident’s financial accounts are dealt with by the home Health and safety is maintained through record keeping, training and servicing of necessary equipment. All equipment checks and servicing is carried out by the maintenance man. Policies and procedures are in place and the improvement plan states they need to be reviewed and updated on a regular basis in line with changing legislation. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 25 The Commission requests that as each aspect of the improvement plan is implemented, the home notifies the Commission in writing. This will enable us to keep records up to date and record on going improvements to the service. Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X 3 3 3 X 3 Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation Reg 16(m) (n) Requirement That the registered person will make arrangements to ensure that the programme of activities takes into account service users past and present interests and is formed following consultation with them. Timescale for action 30/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ladymead Nursing Home DS0000024169.V378432.R01.S.doc Version 5.3 Page 28 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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